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HomeMy WebLinkAbout018-1035-70-110 -0 0 Q o 3 0 h ^ O ~ m cn O C. 6 N ~ O ti Qq I i c I I, ' .a z C _ O LL C O I \t Z Y E Z a`r av+ 00 w CL z 0 c C7 d c m o Z d z o N F- - c E _ a~ N m CL 0 v brp O N C? c ' ►w a C c Q U o d _ Z F Z O N z V N E C C O a o a m c o ° m _ g 0 o c a - L N Z > F- F- F- N N d Z Z O O O ° •N E a a a a E J 04 04 y U II~ rn rn O O O O O o 7 CL c m L" o 3 C O C E l0 0 o m H CD t c 8 IL 0) (D C , ~ c 0) N -0 V O M r,: c "d C N E O 0 O CO O m s a v E E rn m a) CD co E U a~ Co .r V cl C/1 ) M d 7 Xk E L CL .T. C3 CL m.2 d E c c ~~ww a> c m m o V _1 A v a 2 OU) +r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTR4, DIVISION LABOR: ANDS PERCOLATION TESTS (115) MADISOP.O. BOX 7969 N WI 3707 HUaAN ELATIONS 5EIIf(Z ~NF LF'ito/s (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS HIPtitRtt~ Y: OT NO.:BLK. NO.: SUBDIVISION NAME: 41W~/5r'/ 6 /TZf N/R17E(or)W Itgr~~fo.~v / - PE4-., i4.) 6- CSM. COUNTY: 6vyerQ = MAILING ADDRESS: St Ceotl' d"AIR277 RT• I ox (41 WAP-i e--iD Lc~/S. ~SyO/S USE DATES OBSERVATIONS MADE Fin NO. BEDRMS : MCOMMERCIAL DESCRIPTIONrat PERCOLATION : Residence , A X New ❑ Replace MA RCA_ il~o _ ( y c;0 _ GW F 70 FWOS 7- RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: JIN-GROUND PRESSURE: JSYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U S ❑U ~S ❑U ❑S ®U ❑S ©U TQEZ6&1 S- W/ T*o Q° X I IO.J oN If Percolation Tests are NOT required ESIGN RATE: 2S U SO ff. ~ If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate:? Floodplain, indicate Floodplain elevation: 5C5 CeI 10R14_4, fi't' j 5Z3 PROFILE DESCRIPTIONS bvelm tz- f BORING AL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) O' ~I:. B.~ • ( t I. s >3.~ . I oR., 1 $ 3r . S 5 ' t„x B- / ~d `~q•GG -F 8,.$I i '3N. S 1,S &'I"- 5.w Gee 3, o' T,1N cS q r 47 ' Drc a. S T S 83' Ba. SI ? Gk f 3"5 e rovRF-c I_42 B- Z /-D lOp .S~ > O $N. IS f~ r p `/o' if a cS GR r ) /•/(o' ~r.Ra- 1 •33'Gy-r3a. 1.33' 00-:Qa covAF-e B. 3 O s. 16, ' 'i3.a . " s . ; P-A&_ 6~ R . ~,Sr 5~.30r ? r 5 //(,13)r I.P3' (.-I aa. S;t (ceufalY)-)-.2, v' $N. 'ha B. e-ov le &-k IS p_e,,~ Gee w r +t. p o c Kl 4 s 2¢,.A I, O' .F &y. St' eN /-Ore-f-It+ S"DE of 1%Ac(r'ko-e Pif) B- ?,},v C S w i d1ti dl- R , I.o' 11a`5Y• .5,14) (,p~ L1,13a-Sy. 5','/) 1,v' T,4-, S, , 2.0 B- 7.0, BN, n er:Q. S p`,. !.R I,D' ;1"J4 No. 1, 0, Fwo -f to ,s. PERCOLATION TESTS EST DEPTH . WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES + INTERVAL-MIN. -PERIOD 1 PERIOD PER INCH p_ a S rZe-_ $ G.s - S /I /s o B0 L-A APD7- Soils I D P. X12 i tL i t __MOM t T 4 P- I E ~ M I L, ~y ::tz P P- ; 5 fz~ O P_ fN -O(Z tR P_ k / 0 IN c_. 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. It P PE Q •T . N / _ . O O r SYSTEM ELEVATION. I- ~T-0 U; k G_ 9 y o I , t - SE A SLOT P L A tit P C U ' ....._~40 'u 7_~ ~~S/ CD-ul~i T/O.JS S v z.,v S/ r 3 F- ~ S i * usE T,FL~rs ~.v~ y - Dore ~-l~i x%~-►vn SSE " ~r / ~A(~solePTlva "1RE f r.HE.UT 11V SO%/.S w~ STI~'r1f,fS -94 T ARE tior oe" foie M t 'USE` ~ Ilk- y -col S yS 7- A4 1, 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): HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 ADDRESS: HUBERT-IJLMtGHT---- CERTIFICATION NUMBER: PHONE NUM§,ER(ooptional): WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 2y -1- 3P6o - Q /Q S _Np.D0663- CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10183) --OVER *40. v 11 N s ~0 1 "IN z' -zz ~2 m pis m ~oc~o a• In 3oc IN 1-05 -rW .o Z~ :0 y; Nr z 4 N `S g ~ wW n r. m ~ tr ,~i+ ~ ~ t O+ W ~ h 1 I + I I I ~ ~ ~ I Q I I -1 ~ nr I G I rn v 4 I i a I ~ o I y ~0 I ~ R, I +1 I r'►I I ~ r I G ~ V14 I I I d+ c Z ~ ° IL I ~ o I • I I , j S FILED p Z ~~G APR 16 1990a, 457427 ~ JAMES O'CONNELL 3 C{, SL Croix Co., W1 ,'CERTIFIED SURVEY MAP Q DUANE AND LORNA LEWIS q , Part of the Northeast 114 of the Southeast 1/4 'o C. T. H. "T" o of Section 16, Township 29 North, Range 17 West, y Town of Hammond, St. Croix County, Wisconsin, o \ S 00. 36' 57"W 2639.66' being, a part of Lot 1 of that Certified#Survey 4i 50. ~y 2569.6 Map recorded in Vol. 5, Page 1486, Ooc. o Q o O o 397657 of St. Croix County Certified Survey Maps. o 0 • Indicates 1" iron pipe found. 3 0 Indicates 1" x 24" iron pipe weighing 1.13 o `I lbs./lin. ft'. set. 0 o ~ 2 v I W y N OWNER' S' AOORESS : Route 1 I e o° ? e ; Hammond,.WI 54015 • M O v ~ j N I o m tu " 2 ti ALL BEAR/NSS R£F. TO THE EAST L/NE OF THE SE 114 ~I q v j OF SEC. /6, T29N, R/7W, ASSUMED S00.36'57 "W q q W V Gi ~ e CI C►I ~ ? VI ~ I ~I M Z I 1 g Oated: March 10, 1990 N ~ O N 0 N n S 00.36'57"W 173.42' y e. q o d Z a a s, \ o o 9tJi qo7 ONV ` o OWWN tii 3 WCtf31. MdW0`J I m _ AIM= woad '.Ls 066 9 1 M 11 q1- h O V ~ ~I I 3 ``t~tt~tttu/rah Q W q SGON V": ku q; %U o a u y LAUR E i 1713 o J :N ER •~L F • ALLS W W N N i• i o N N00•36'37"E 223,42' Laurence W. Murphy 3 m Vol. 8 Page 2195 Registered Land Surveyor a Certified Survey Maps, St. Croix Cty., WI SHEET / OP 2 . --.-tea FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_ f ~7 `rwA TOWNSHIP hl M-6-A4 _ SECTION_T-:11 N-R 7 W ADDRESS-&Y. 1W / ~~`S T. CROI ~ - X COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE ICI PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM V ~ N _ r lot ill OQ' ` ~ $ a ti: `I t 00 a i ' r it • u• INDICATE NORTH ARROW cHl!I~~RIC.~ BEN :E1 vati and de scri ion: Alternate enchmarAA F ,...,,A SEPTIC TANK: Manufacturer: Liquid Cap._f&'6_0 Rings used: ~I-Manhole cover ele • 6,3,a/ a ' J. I v. / Fin~ grade elev: l ? ? 57 Tank inlet elev.: ,~6_~Tank outlet elev.: 00 No. of feet from nearest road: Front , Side ~ , Rear Ft. 79401 From nearest prop, line:Front , Side , Rear &,-'Ft. /.-2// No. of feet from: Well, ~o , Building: : 6 p 2 (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. I~ Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: ke"' Seepage Pit: Width: .s ` Len th F 7 N -it -V 9 umber of Lines: . Irea Built It5'S•,,,~ Exist. Grade Elev. !'s~ loo. proposed Final Grade Elev. ~q, ~ Fill depth to top of pipe: No. feet from nearest prop. line:Front_, Side Rear Ft._WAAq^a No. feet from well: ~TS" No. feet from buildin 9_ 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: _1,9 DATE : ' PLUMBER ON JOB : LICENSE NUMBER: 3 S'8 6/90:cj ,P d LOCATION: HAMMOND 16.29.17.253A-10,NE,SE,16,CO. RD. T, LOT 1 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and H-,pan Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 149258 Permit Holder's Name: ❑ City ❑ Village)f] Town of: State Plan ID No.: GERHARDT ALLEN R & LUANNE C HAMMOND CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 018103570110 TANK INFORMATION ELEVATION DATA A9200101 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ICn 24 , 11 Dosing U 0.6~ O Aeration Bldg. Sewer , 6 Holding St/!Inlet 5,53' TANK SETBACK INFORMATION St/ bit Outlet 92, p Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Septic 2&V NA Dt Bottom Dosing NA Header 'i. I 97, 07' Aeration NA Dist. Pipe 1`/ , 9~.9Z b. 11 Holding Bot. System 5 9'23 9(' ' PUMP/ SIPHON INFORMATION Final Grade K °rs'r• ' Manufacturer Demand l :z -y Model Number GPM TDH Lift Friction System TDH Ft Head Forcemain Length Dia. Dist. To Well T-1 I SOIL ABSORPTION SYSTEM BED/TRENCH Width _ r LengtF) / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 g DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER ~ Model Number: System: rrrtC 59 Z- Z OR UNIT DISTRIBUTION SYSTEM Header /A49fti4ekl rI Distribution Pipes) r , x Hole Size x Hole Spacing Vent To Air Intake Length 1_1__/ Dia. _4L Length g1t8V Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over if Depth Over rr xx Depth Of xx Seeded/ Sodded xx Mulched „ rr $e41;FTrench Center - Bed /Trench Edges - qZ Topsoil C] Yes E] No ❑ Yes E] No 3 Z COMMENTS: (Include code discrepancies, persons present, etc.) \ f1-h oc,~ G} C ono`" c car ~ ~R. 4a P do ~ ~ Plan revision required? ❑ Yes (i'N'o Use other side for additional information. log I ZL24 SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: (may SANITARY PERMIT APPLICATION couNTY ZJ fflLH In accord with ILHR 83.05, Wis. Adm. Code . 61&4 STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ of 8% x 11 inches in size. c eck re won to revious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTJQNE~.. nn PROPERTY LOCATION ,Q~,N al a.Q '/a $ E S T, N, R E (or PROPERTY OWNER'S MAILING ADDR LOT # BLOCK # 4/ CITY, STATE ZIP CODE PH NE NUM ER SUBDIVISION NAME OR CSM NUMBER 13 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ~y ❑ State Owned LLAGE 7' ❑ Public L=J 1 or 2 Fam. Dwelling-# of bedrooms PAR LT . UMB R() d /v / ,v~ 7L r III. BUILDING USE: (If building type is public, check all that apply) 1 0 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 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OAF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. LI New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 19 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 (s q. ft.) (Gals/day/sq. ft.) (Min./inch) r yyW+ qG, o~ ELEVATION 4*Sy t'D r ` 9yFseett 9A 917 004 t VII. TANK CAPACITY in allons Total # of Prefab. Site Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncret Con- Steel glass Plastic App Tank Tanks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber 1 0 El I El El El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print):, N y; Plumber' ignature: (No Sta s) M MPRS o.: Business Phone Number: -7 Plumber's A ress (Street, City, State, Zip Code): ~G7 l~ G a~ `fi'b ~3 IX. COUNTY/DEPART ENT USE ONLY ❑ Disapproved Stary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse D termin i n 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. Yobr senttary\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 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. 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 of system. Check appropriate box depending on system type. Vt. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new arid/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 tacks; 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 1154orm; and F) all §igitlg 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) STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County i OWNER/BUYER ROUTE/BOX NUMBER_zf~ f zF ~ FIRE NO. ~U 3 12 CITY/STATE /Ct./v7_~Ci~.ea' ZIP PROPERTY LOCATION: R 11/4 /4, Section , T N, R 7 W Town of /c~~,•Yt~ , St. Croix County, Subdivision , 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 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 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. SIGNED 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 tIOG n _ Y n. 'r. ~ - ~ F: ~ ~ ' ~ ~ v a , a. ti L a. _ i fit..? . : _ 'w - ~ , .~r~". ~ i I j DOCUMENT NO. I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 PAr REGISTER OFFICE ST. CROIX CO., WI Duane L. Lewis and Lorna D. Lewis, husband ReC'd for Record and wife, aka _p-cane---- -.-s a_nd..Io-ma .Lewis.,.. at (V; AY C 41140 husband . -and..wif_e - - 11: 30 A. M _ conveys and v,arrants to _.Allen R. Gerhardt and Luanne C. Gerbard_t,_.hu.sbandand_.wife-,-__as__marital--property OW Register ofDee& with- rights--of-_-survivorship.-..••- - the following described real estate in St.__-Croix - __--___-•_-.._County, State of Wisconsin: Tax Parcel No: Part of the Northeast Quarter of the Southeast Quarter (NE4 of SE4) of Section Sixteen (16), Township Twenty-nine (29) North, of Range Seventeen (17) West, being part of Lot 1 of Certified Survey Map filed in Volume "5" of Certified Survey Maps, page 1486, as Document No. 397657, described as follows: Lot 1 of Certified Survey Map filed April 16, 1990 in Volume "8" of Certified Survey Maps, page 2195, as Document No. 457427. i IE. Lrk This 1S___I7-Ot---------- homestead property. (is) (is not) Exception to warranties: Dated this day of MY 19._90.. (SEAL) --------23 - -------(SEAL) * Duane L. Lewis -------•----------------(SEAL) . j''° -----(SEAL) T * _Lo.rna-.D-__.Lewis-------------- AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix County. authenticated this day of__.-_....-__•_____..___.•-, 19 Personally came before me this ________________day of aY------------------------ , 19__ g Q_ the above named Duane L . Lewis an Lo_ rna D . Lewi s * ---------------------------------------------------------------•-------------T TITLE: MEMBER STATE BAR OF WISCONSIN ' (If not- S authorized by § 706.06, Wis. Stats.) to nio'known.to be the person who executed the ;£a'rem iil~,tlznent aid ac owledge the same. THIS INSTRUMENT WAS DRAFTED BY R,. - ^^f / s-a-------- Re nstra, Van Dvk & Needham, S _ 1 p L tote ~_U<U•Sc~-_ 201 South Knowles Avenue, Box--- o . ; New--RichmQnd•,--.W1----- 5.401.7----------------- 'a " i lotarv Publir#=.}= 5t-.__ Croix- County, Wis. (Signatures may be authenticated or acknowledged. Boths ,M.Nr (Commis~oi~ is permanent. (If not, state expiration are not necessary.) ~'r•: 02 c %I - - - - 'Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAIL OF WISCONSIN Wisconsin Legal Blank Co. lnr. 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 L, Y, 4T Location of property 1/9 --Sr-1/4, Section T~/p -N-R~ 7 W Township d 0- AM to en A✓G~ Mailing address &T / .pa,k t1c..j~Lf 1'J!f e1'U cz1 Address of site / ~"tir'~--r''t~►'t-. Subdivision name Lot number Previous owner of property. Amtc. Total size of parcel Date parcel was created- Are all corners and lot lines identifiable? - Yes No Is this property being developed for resale (spec house)? Yes "No Volume gle3--and Page Number ,,zO 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. 415F' A dy a ; 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 system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. Signature of Owner Signature of Co-owner (If Applicable) Date of Signature Date of Signature DEPARTMENT OF SAFETY & BUILDINGS INDUSTRY, REPORT ON SOIL BORINGS AND DIVISION, LABOR HUMAN AND PERCOLATION TESTS (115) P.O. BOX 7968 it , $01 II (I LH R 83.09(1) 8t Chapter 145) MADISON, WI 53707 j I Ni S N: TOWNSHIPtItiAtffiltt?tPlrtt'fY: OT N0. LK NOL:jSUgDIVISION NAME: • 1/ /T 2I N/R/7 E (or►W ItI1MM 0A-) / - Pev i.vG- CS M. COUNTY: 6infro, MAILING ADDRESS: 5i. C U r A of 11-,c4---1 G E A! ti IQp -RT I 'Qo x 141 OAAlmo•3D t!(*S' S" ;/d/ S U E DATES OBSERVATIONS MADE BEDRMS.: JCQ-MM R AL DES RIPTION: t~itr ROFILeDESCRIFTIO ; ZResidenca ~I 447 New ❑Replace "ARC (v4,,Zgp ~ RATING: S- Site suitable for system U- Site unsuitable for system ON EN t NAL: M ND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM:loptional) ros CCU gl-S 1:1U QS C❑U ❑ S ®U [I S ©U TREA)e415 - w/ 'i~o R o x l I oN ~ If lation Test; are MQT required DESIGN RATE: 250 Sq f(. - j [,npd:@,rrcso. ILHR 83.091fItM1, indicate: If any portion of the tested area is In the Floodplain, indicate Floodplain elevation: 5cs 41 14 4t&,40 " i 5:r-3 PROFILE DESCRIPTIONS ; :L~ bIrcr.,R1. F4. BORING AL' DEPTH T QROUP DWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, EIFVATION ORSERVED EST. HE TO BEDROCK IF OBSERVED SEE ABBRV. ON BACK.) r i 0• ~K• Bps • 1 L S $w . IORH $r. SI - 5" Aii . i u • S I. $ Ba • i~ . 5 w .6R 3. Q -rNj CS A r ! G7 ' D,~' S T S 43' $,4- S) ? 6R 3. S COvRk hae B- 2 /•O /Po -TD > 9.0 73w. 19 r u.~ gd~lurA, j/0' ?•1 ,j 'cS ? G-R . .3 3 ' GY- t3a • 1.33 ' oR- Q..i Boa k B. 1~( • /`O ~a^+ 9R 1 s, 16 13a . /w ArQ S . ? P-Adk ~R . r r 30r c ' ~r• (ice, . sil) l.~'3' ll• 945 (Cpt.ns&, , ~ v ' ;w Y) B- .l cov Rbr~ IS 6rC a, 1'i4, pot,Kt f S 1. p.i OF tfy, S'i ou ~+oR /t. S DE of AAe-(C&.0t f•} 1 , S ' 3; ) G4R `I-oa~tuyt:. ~a. ~ 1.01 T~f~ s~' , 2. 0, S ~.0, ~ ~ I.O • 84- 5y. S . B- ErJ. /rr Aj . S p-iw b'~ I.O f w t •f.4•a S' . PERCOLATION TESTS TEST DEPTH ...TER IN HOLE TEST TIME DR 1 WATER LEVEL-INCHES RA MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. p t p t PER INCH P. o ` Tz/ II e gjjnj l - / c! ~l S /)ISO 8V eA 4,eDr SGYIS 0 P. It iT P- /M 1 1' P- i 2 0 AV.L P. tN o P- IyN.tiw~ t S INC... • 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 alev4tipn 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. 2t PPE A T le FNe& 00 GO W I-& r SYSTEM ELEVATION, Tree' CIA_ /7• 3 Q ~j -T i_ I ; II l , $e ~ ~I..o T ~ ~ ~ a ~ u •sr R S si l _ E SvA.r.~~/ ~ 3 F t b~s7 r i..- TN ►x 34; f _i ..._i ~ Q _.1. i , ICE T E,t1G(,f f D.vL J/ - fDI? f-I~1 Xi~f(>/"1 s/ - -6 00 Tlna 3 ii?En-•NE.uT /ti Sor'/S 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, anj ghat the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print : HOMESITE SEPTIC PLUMBING CO. TESTS WERE COMPLETED ON: 655 O'NEIL RD., HUDSON, WIS. 54016 I~R~ ROB ADDRESS: 8lilfiHfi CERTIFICATION NUMBER: PHONE NUMiR(optiorWlJ: WIS. MASTER PLUMBER LIC. N0.3307 M.P.R.S. 2 y ~-Z 3-P6 Q / QQS MINN. OW CST SIGNATURE: PO" DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. OILHR•SBD8395 IR. 1q/31 OVER J N W ~ a ~cmp IN uQ1i~oca ti 5s 8-, z G5 n u' o c ~a$ lip p N z ~ l~1 wW ~i r. 61 N - b Of m an ; y, a ~ p C3 rM CIO Joy vi N I I I I ' I ti -a ,o I b°-~~ I c C I I nl I O 1 {T► v ~ I i N I 0 I -1 ~ 0 I ~ z I I ~ ft, I ~ I ot. o L y y ~ I d. ~ of a I ~ 1 Z ° IL ~ h ~ 11 ~ o I Z I I I ~ i C, D . `T fi ,aka.. Q + \ D i t 4t w i t ~ O-V z f' f`' V 14 s r 1 a i slow s ST. CROI X COUNTY Y• 41vl WI SC O N S I N ZONING OFFICE 7 9 6- 2 2 3 9 tr T t P.O. Box 227 Hammond, WI 54015 HOLDING TANK PROCEDURES DUE TO THE MISUSE OF THE HOLDING TANK PROGRAM, THE ST. CROIX COUNTY COMPREHENSIVE PLANNING, ZONING, AND PARKS COMMITTEE i ADOPTED ON OCTOBER 16,11979, THE FOLLOWING PROCEDURES. THIS POLICY IS EFFECTIVE AS OF THAT DATE WITH THE INTENT TO BIND THE HOLDING TANK OWNER TO ITS INTENDED USE. 1. Township Agreement 2. ftne-X/Pumpen Con.txact 3. State Ho.2d.ing Tank Appxovat 4. $100 j e e ptub n eg utax d an.itaxy j e eb . The $100 is intended to pay Jot pexi.od-i.c site inspections and o j j ice tev.iewz 5. Month.Cy Pumping Repo,%t. The Monthty Pumping Report wilt be the xe6 pond.ib.i&y o6 the pumper. REPT131 HAMMOND ST. CROIX COUNTY ZONING PAGE 1 04/08/92 10:23 REQUESTS FOR INSPECTION WORK SHEETS FOR: 4/ 9/92 AREA: JT-- Activity: A9200101 4/ 9/92 Type: CONVSEPT Status: PENDING Constr: Address: HAMMOND 16.29.17.253A-10,NE,SE,16,CO. RD. T, LOT 1 Par,,cel: 018-1035-70-110 Occ: Use: Description: 149258 Applicant: GERHARDT, ALLEN R & LUANNE C Phone: Owner: GERHARDT, ALLEN R & LUANNE C Phone: Contractor: NECHVILLE, HENRY Phone: 749-3322 Inspection Request Information..... Requestor: NECHVILLE, HENRY Phone: Req Time: 02:04 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION D minu~K Inspection History..... Item: 00012 FINAL INSPECTION