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HomeMy WebLinkAbout038-1116-70-000 ti ~ o ~ O N N C M of Cu a~C N N > r^ C C N s _ N V N d 4 NL O CL i (0 I C = L C N U LN 7 ti N 3 L r N ~ N N ~ C O N N c z 3 ~ c ~o 0-0 ai LL C O) p _O O C w .C 0) C ~ - C m TS N C C N ~ N O ' f9 O E ¢ N U u- _ V Co N z o v £ o z m d CL m z 0 z v U O N (n I- Y, N C N N C N O i (6 N 7 ~ N N N N • N a N Nc l'V C 'p ~ O Q © z m z N N C ~ N 7 IAA ~ N L LO N L C N G m O 'tV'!~ O N N i N N VIII Lr) 0 d 1] 4] 16 O O O •*w ~o n.n.a tea a N N *~w (n 0 M Co v~ U rn rn T Co r-- D) Sri I', N N OM C N O N 0) -2 O O = 0 M N (O Cl) m C n m N C ~N 00 N Q N O 79 O p► L' y~j N O C C N C O O L C ni ZD N (D (D O pOp ~ Q' N C_ N n- 0 0 0 O I~ V N Y a N N N L O O U C a) 00 N 'd' M O N _ d 000 L ~ M N (6 E U • C. N fn m O h (n m a A p # L1 i d • a. N ,V N y c r~ i C C 7 U a 2 O in U - w , STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER,ice . pi°')- '60 lOlJ1 ak ADDRESS Iq `j o ri'v e.Y` 5 2.i` Lj , SUBDIVISION / CSM# p LOT # SECTION 2! T N-R j 0 W, Town of 5-, cL r In i ST. CROIX COUNTY, WISCONSIN ~gT PLAN VIEW =y. SHOW EVERYTHING WITHIN 100 FEET OF SYSTE a U4 ~1 ~ h , L 1 I / INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. } BENCHMARK: 8(.SAL Q ~ C4 ~ ) ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING.TANK INFORMATION Manufacturer: tA) 6` S Liquid Capacity: i Setback from: Well U /,/,//.,,use Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: d Length 36 / Number of trenches AID /a e Distance & Direction to nearest prop. line: Setback from: well: 14 e111 louse a Other I i 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: ~f PLUMBER ON JOB: c)rV J/Y LICENSE NUMBER: 331 INSPECTOR: 3/93:jt I'Q~sc 's ~ artr r i d C . 29 , T31N PRIVATIf ?eWA6E SYff dM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitary Permit No-: 193478 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: OBERT STAR PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300141 6 a q3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic cl~lc. Pre ~ ,~O ,6-,//, Benchmark Dosi Aeration Bldg. Sewer Holding St /inlet 7S TANK SETBACK INFORMATION St/ H;` Outlet Ventto TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet Septic 7z IX NA Dt Bottom Dosin NA Headers Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufa Demand c- Model Number GPM TDH Lift Friction stem TDH Ft Forcemain Length Dia. ist. To Well 2:11 SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No Of Trenches PIT No. s Inside Dia. Liquid Depth DIMENSIONS /,p DI EN I N SYSTEM TO P/ L BLDG WELL -6~STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O i Mo tuber. System: a?Q ~~Q N/ OR UNIT DISTRIBUTION SYSTEM Header / MWrf"ld Distribution Pipe(s) , x Hole Size x Hole Spacing Vent To Air Intake Length c~ Dia- `f I 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/T44afi6aCenter Bed/Tj&U&4 Edges /4 ~ Topsoil E] Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) y~LOCATION: ~NW,~NW/,°SEC.29,T31N-R18W (93RD STREET) I Plan revision required? ❑ Yes D-19-0- Use other side for additional information.I -:V 13Z? I , SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: A DILHR SANITARY PERMIT APPLICATION COUNTY 1 ~,R 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 ❑ y 2 4P 8!z x 11 inches in size. Chbcklf 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 ERTY LOCATION o zr4 et)d l vv; e. Y. /e a,S Zg T3/ ,N,R/Y E or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # >9 8 '93 4 Sf CITY, STATE ZI CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER rner , ~-1 Q/ S N7-S853 ,d II. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned ❑ VILLAGE ~J.,, - PrCL fry _A C (X J 19 WN W: ~ ❑ Public 141 or 2 Fam. Dwelling of bedrooms-3- PARCEL NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 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 90 Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. 9 Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 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 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ 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 51 .5 0 1 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) LEVATION //o - tl b /c~ ,t . .7 15 Feet 42 Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Hoidin Tank !10 Q~ Lift Pump Tank/Si hon Chamber I El I E1 F~ F-1 F-1 F-1 VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum r' Signature: ( to MP/MPRSW No.: Business Phone Number: 7 ~r 6- 761 PI bar's Address (Street, City, State, Zip Code . IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing A nt Si nature (No m Approved ❑ Owner Given initial) Surcharge Fee) Adverse Determination jL~CJ / X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-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 Wis;o sin Administrative Code will be applicable. 3. All revisions to 0--trmit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit rr-ansfer/Reiewal Form (SF1,F) 6399) to be submitted to the county prior to installation. 5. -Onsite sewje cyst+-rns must be propeny maintairlatl. The tank(s) must be pisnr;-ted by a licensed pumper wherever 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 numbers) of where the wstem is to be installed. II. Type of building tieing served. Check only one and complete # of bedrooms i! 1 or 2 Family Dwelling. ill. 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 o. °,iystem. Check appropriate box depending on system type. VI. L~bsor { :as system int-srmation. Provide: al! information reques,4-4 in #1 7. VII, Tan',,. .c.jr:-ation. Fil' ir. the capacity =ry new and/or eat ?:ink, iist io foul gal'onF nuni"er of tanks and - anufacturer's name. Indic::: arefab or site con! and lair material. for all sep0: ; Y4,;•.,,/siphcn and holding tanks tsIis system. ChF. lerimc-: 4 nproval only tar ks received exper r,roduct approval frorn D : ~,'1 Vlli. Hesponsib!iity statement installing -s to fill in nar ' ne,~se n+.--,Io, with approp, +te prefix (e.g. MP, etc.'), , l:dress and phone number. ~rYsi.,er -nust sign, r r..Ilicatlon form.. rX Coun,ty;Department Use Only. X_ County/D-partment Use Only. Complete specification ;,-~t -It!!er than 8% must bC t>ul rr rt t_~ f 't- county. The F`'< !3s r ,tCii_.ie the fof~a~°~i,lg: .l :n, drawn to -rith corno le±r iecation of f oit n C to or c.; w trrent t ..,iks' w'.tfdr SerVIC:e; soeams a-,u ir• pj!mp or soph _ n iJSt` ibl+trJn b--,Y-. -bci or wkji* r i -:wnent system ar4;t" and +"r, of Ole c turn 3) honz<< t-, yr rtica "i r points; l..sr C) complete spec ;,cations for pun s; .rid controls; Jose .:-~ievat:or fr :a;on loss; pump performance curve; pump model and pump manufacturer. 1) ) cross section of the sciil av)sorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 VkiscorCSV Ac; 410 included the ( f cttih:`'. of surcharges (ti's; - i lor 3 nr.rr,5!, ^ rer! I :Yed prac' ::es wtiich car: effect groundwater. The ,;!()Hies collected through these surcharges are used qi water contamination inve0gatrons-and establishment of staf,! arils. • SBD-6398 (R.11/88) f ' S T C - 100 This application form is to be completed in full and signed by fthe owner(s) of the property being developed. Any inadequacies will only result ~n delays of the pormit issuance. ,should this development be intended for resale by owner/contractor (s ec house), then Ia 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 Cf d Location of property1/41/4, Section T'/ N-R Township Mailing address C e- VZ_ P + GLJI Address of site y q Z-J c )~f ~ l~vsP7L ~15 -yy Subdivision name Lot no_____~~ Other homes on property? yes- No Previous owner of property Total size of parcel X oZ oZO Date parcel -was created /v o2 /f~~ 'Are all corners and lot lines identifiable? X Yes No is this property being developed for (spec house)? Yes ...,ZNo Volume-1:1/75 and. Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WAR%kNTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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 o fice of the county Register of Deeds as Document No. , and that I (we) own the proposed site or the sewage disposal system orreI (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in t lie office of county Register of deeds as Document No. 4 Signature of applicant Co-applicant AKe Date of Signature Date of Signature DOCUMENT NO WARRANTY DEJED THIS SPACE RESERVED FOR RECORDiNO DATA STATE BAR OF WISCONSIN FORM 2-•1982, 4606 - REGISTER'S OFFICE ' - - ST- Mn John G. Fischbach and Muriel E. Fischbach Husband and CROIX CD., } P Reed for Record Wifei..James• K ,_.Glenn and Cecilia K. Glenn, Husband nd ife.. ......W JUL 0 21990 of 12100 P. M ti t conveys and warrants to E t'ra4r$e•.R.~_.Bodlovick. and..Dorothy,......Bodloyick F r i i ( f....................... RETURN TO 1 ~r the following described real estate in .-St..-.Croix ...........................County. State of Wisconsin : Tax.Parcel No: __.038-1116-70 i' Part of the NW 1/4 Of Hilt West, St. Croix 1/4 of Peation 29, Township 31 North, Range 28 County, Wisconsin described as follows: Da93nning at the Southeast corner of the NW 1/4 of NW 1/4 of Section 29-31-igr thence North along the East line thereof jsda3 feet; thence West to the Past shore of the "id Riv+rt: ofUwNWuv0 lvuU1%`ly slwiy said RaIaL aLvA* tv tlk* 9,:rUth IiUi yr said NW 1/s 1/s; thence Lrast along beginning BXCZPT the North 60 feet theref. said South liI>te to the point of I I, It }k {{t (f This 18.._---------------- homestead property. } } (is) (is not) el Exception to warranties: r~ ~ f } Dated this .......2 °d day of June. 19.90.... + (SEAL) .(~f~,Ge~C~. Q (SEAL) John G. Fischbach l1el E. Fischbach t• (9-7-.Sj,t-............... (SEAL) ~amea : "G enii Cecil"ia "K:""Glerlit~? (SEAL) j~ X AIITHBNTICATION ACBNO W LBD OMENT Signature (a) STATE. OF VFMMQMM Minnes to ~r ess. i County. : authenticated this .ZZrit$ay of__,IJJAg 19..Q_ Ramsey Personally came before me this 22nd------- day of t• 1JJJJLe-------------------------------- 19.90... the above named t John G. Fischbach and Muriel E. Fischbach, ` sballd aGl Wnfe Ha' << TITLE: MEMBER STATE BAR OF WISCONSIN James"-K.______en_ and Cecilia K. Glenn - (Ii DO Husband and Wife f aho by ;f 706.08. Wis. States.) to me known to be the person -q. who executed the foregoing instrum nt and acknowledge the same. j THIS INSTRUMENT WAS DRAFTED BY 0"L A Pirst Security Title = - p . M K Salwasser 2785 White Bear Ave., Maplewood MN Notary Public ._"Ramsey County, Minnesota (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) Mach 6 t date: ._._...-..-r---._........••--.~'•"~-----°'~::=ac..~•-;0.. - *xamM Of persona signing in aRF eapacitr should be typed or printed blow their signatum. "~r FU' iC. MINN ESOTA F:A Jt.7Y WARRANTY DEED STATE BAR OF WISCONsin wiscoasia•.)esAl._~ilenk~(;w° FORM No. 2- 1982 NJ -.rrh..• wi•_ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, C DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 5739069 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: N: WNSHIP/ UN ICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: ~1/ &'1412 1j&.N1R14 r, Z, COUNT : / MAILING ADDRESS: USE DATES OBSERVATIONS MADE ,Z o2 Sf,$" NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLATION TESTS: ❑New Replace ~~.246 JKResidence 1 -1 RATING: S= Site suitable for system U= Site unsuitable for system v CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) CIS ❑U 13S ❑U $ 2U J ❑ S ®U s 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: I 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.) 09 •~e✓s% yWn 5 / ,P- Y - 7a / s- B- 7.2 7,74 B- B- G B- B- B- PERCOLATION TESTS TEST 15EPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- G P. 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 fs = Z , P ~'VS^ fiv< V Kr r y Ord 0 ; i s 149 b ell f? a~ of 11> i~- L' 11' 4r L E i r - t I, the undersigned, hereby cert y that t e soi tests reported on is orm were ma e by me in accord with the procedures an methods specified in the Wis nsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (printI r TESTS WERE COMPLETED ON: ADDRES CERTIFICATION NUMBER: PHONE NUMBER (optional): CST ]IGNA U RE: 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 - SOD - 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; 6. 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 '1 - 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. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 769 N WI 53707 HUMA,N~fiELATIONS (ILHR 83.09(1) & Chapter 145) I WATION: SECTION: WNSHIP/ NICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: U/4 ~1' /T Z N/R E 1 -f,''//'o. ~ff$ COUNT : MAILING ADDRESS: rliro~x oOQ rf 0 i r ' p/!?~r All • D S~ USE DATES OBSERVATIONS MADE NO.'BEDRMS.: COMMERCIAL DESCRIPTION: PROF IL SC I ONS: PERCOLATION TEST : Residence 3 ❑ New Replace Q ~~6 ~O a p~6 ((RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) SS DU OS OU 11 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- l 7.2 yli 1 B- B- B- B- PERCOLATION TESTS TEST EPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES P. NUMB/ER I AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P_ C2 its P- G 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 SS = Z P ao td-/ ~'aY o f 634l P}•~ s _ 16 f~~Flc ~c~ S Be D 5T low {Q . _ ~ OPP O/~/ /!°ts r- 041L ox, I, the undersigned, hereby cert y that the soil tests reported on is orm were made y me in accor wi a proce ures an methods specified in the _e W11 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: ADORES CERTIFICATION NUMBER: PHONE NUMBER (optional): CST SIGNA U E: DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. L S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER h©bev_+ _Rod / 1/1e- ADDRESS M FIRE NUMBER_L! L7 CITY/STATE YY1PV.S2i I ZIP- a S PROPERTY LOCATION: Z_/V1/4, 1/4, SECTION_F , T_.g/ N-R Z;~ W TOWN OF_ St. Croix County, SUBDIVISION_ 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 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 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/tae, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. n SIGNED DATE • St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 PLOT PLAN paOJECT_ ADDRESS/I1 / 9,?ro1S1 .So'nerlel- - / ?~4 A)01/4/S zq/T3) N/R TOWN .S all Pa;-,`e COUNTY ,S;I Crvj,( MPHS Lyron Bird Jr. 3318 DATE -Z z/- BEDROOM3 CLASS PERC 1 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT_ MOUND_ HOLDING TANK SEPTIC TANK SIZE 2d60ga I LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ABSORPTION AREA 630.-4 z PERC RATE , Z_BED SIZE Benchmark V.R.P. Assume Elevation 100' Location of Benchmark _7422 pO4 6 s U.^ z * H. R. P._ a,o m r~ - - -_-fir 0 Borehole Q Well Scale Feet O Perc Hole System Elevation _is, Uent 12" TYPAR COVERING 2" 12" 3' 4 6' O 3' 3' `:J 3' I 6 " Sewer Rock i 12' 18' a ~v r ~ coo ~ , ?s - ~ I s/ ~c' I I 5' o x 5 0 1 Dose G~ Rem o ey t l i COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO*** 05468/01 PAGE 1 ST. CROIX COUNTY REPORT DATES 5/25/90 COURTHOUSE DATE RECEIVED' 5/23/90 HUDSON, WI 54016 ATTNS THOMAS C. NELSON 2~. 31` !-~d OWNER: Glenn/Fisbach LOCATIONS Town of Star Prairie COLLECTORS M. Jenkins SOURCE OF SAMPLES Bathroom faucet COLIFORMS 0 /100 ml INTERPRETATIONS BacteriologicalLy SAFE NITRATE-NS 2 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria/100 mL Nitrate-Nitrogen, mg/L LAB TECHNICIANS Pam Gane WI Approved Lab No. 19 [~yOE,`NDEPEN~FNr u ! Means "LESS THAN" Detectable Level Approved by# ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 ivll ST. CROIX COUNTY ZONING OFFICE St. Croix County ' 911 4th Street a~ Hudson, WI 54016 J Telephone - (715)386-4680 ~ The St. Croix County Zoning dinffhe serviceFirmsof and water inspections to Lending Institutiona private individuals. an be of this form is essen so a opted. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning officewill , bando mail, along with form to the above address. soon as possible after fee and form are received. WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 WATER TESTING (For VOC'S) --FEE: $25.00 SEPTIC SYSTEM INSPECTION if system is properly functioning at.t me of inspection) NN ~i s bct Property owner s name Property owner's address Legal Description 1/4 of the _174 of Section l° I T3/ N-R_2 ~fu -76 Town of ,star pra'iri2 Lot Number Subdivision Name ►I I TAX X BOX NUMB= GAU all eol l h45 /lei Color lor of house Realty sign by house? If so, list firm: )DV' . C G?"o 0,f /4~nf(~ 4V 4t '60 P1,UeO0 gorw~ o pLBA$N INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOM" WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. this is the case, please make proper arrangements with this office to ensure time when entry may be gained.l Firm or individual requesting services:-T/-i Telephone Number ss - O REPORT TO BE SENT TO: "Rkagt Closing date Signature t ST. CROIX COUNTY *y: WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ° 911 FOURTH STREET • HUDSON, WI 54016 - - (715) 386-4680 May 25, 1990 Jim Lagoon, Realtor Burnet Realty 2020 Washington Ave. Stillwater, MN 55082 Dear Jim: On May 22, 1990 I collected a water sample from the Glenn/Fishbach property located in Star Prairie Township. It was sent to the laboratory for testing, and the results will be sent to you as soon as they are received. The property was also inspected in an attempt to evaluate the septic system. No evidence of a functioning system was found. Should you have any questions regarding this subject please feel free to contact this office. Sincerely, via Mar J. Jenkins Assistant Zoning Administrator dd A ~ 5t,- oUlutJ r~_~ ,rte eau 929 Awir_.Lw~eu c~.L w 4144 61 ST. CROIX COUNTY t hY~~ tkJ ` ~h ! WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE ` 911 FOURTH STREET • HUDSON, W154016 _ (715) 386-4680 June 22, 1990 Jim Lagoon Burnet Realty 2020 Washington Ave. Stillwater, MN 55082 Dear Jim: I returned to the Fishback/Glen property located in Section 29 of Star Prairie Township on June 21, and was met on the property by James Glen. A second attempt was made to locate and evaluate the septic system. Mr. Glen pointed out a "mound" area which it is assumed covers the pipe coming from the residence. He also told me that there is a tank below the ground surface, and at some point in time the cover of the tank has been replaced. As no excavation was done to inspect the system, a determination of compliance cannot be made. Further, as the residence has not been occupied for an unknown time period, it is not possible to determine if the system is functioning properly. Should you have any further questions, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj