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{ DEPARTMENT OF REPORT ON SOIL BORINGS AND
SAFETY & BUILDING`
(N,,)~irw,,,; R Y, (t L7
HUMAN PERCOLATION TESTS (115) MADISON DIVISIO(•.
RELATION P.O. BOX 796!
~J , WI 5370
r'. (ILHR 83.09(1) & Chapter 145)
i IV A ION: SECTION: T0 WNS1HIP/~: LOT :BLK 0.: SUBDI I ON NAME:
kj W 1/ /T /R to T- To S e
COUNNTY- OWNER'S BUYER'S NAME: LITIJU ADDRESS:
Sl
USE Q! G ►aK~~~ hJ , Si/o%
NO, BEDRMS : COMMER IA ESCRIPTION: DATES OBSERVATIONS MADE
Residence ~Vew ❑Replace P I N A MVFn TS: !
RATING: S= Site suitable for system U= Site unsuitable for system
CO V TIONAL: MOUND: IN-G OOND-PRESSURE- SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional)
❑u as u sou os emu os RU
If Percolation Tests are NOT required DESIGN RATE:
' under s. ILHR 83.09(5)(b), indicate: < C ~5 If any portion of the tested area is in the
Floodplain, indicate Floodplain elevation:
' PROFILE DESCRIPTIONS
BORING TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH W ELEVATION OBSERVED EST. IGHE TO BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.)
B' l r/7 /O/.r7Y~ /~(l0ht 9,/'~~ .S8 6~s/, . s'SQ.~s~.9x B.► s~y•~,33'~3•~~s',9
sBH-~ /7 S ,OS
-s
B Z q , Sp 00, 5 $ . 58 ,/,5 , • S $ Q~ s/ • 9aD„ ~s~9 9i l3.~ ~.sg.
y~ s Z B-
0
B- ~ r// /7y~ / / ~ ~ `'Y2 4OP17 /J 1 ~jil". 9.2 6H s,41 21 0, 74.nts fir.
B- y B S
7 q Jr-. 9„L_ 6 . S~/s/ . -/.z /S .3' y . 3 s e"., s
. ` i l~~t....
7 L
7
B-
PERCOLATION TESTS
TEST DEPTH WATER I HOLE TEST TIME DROP I WATER LEV L-IN HES MINUTES
NUMBER JZQ= AFTERS LUNG INTERVAL-MIN. p RIO RATE
P 7 10122 PER INCH
P- i r 3
P. z
P. 3 5 S s/
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 9y9~-
11
64 Of Ziff- Q Ligt' e~ S~~ti~ 1VrkrS(c~'
I {A/
!
ly
100
: ibp o
' jao
gam' 61esly
01
tN.
d
i Ir r I ~ ! I ?
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3
{ :140
1 ' I -
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 '
TEST WV;ECIOMPLETED ON:
ADDRESS:
CER IFI ATION NUMBER: PHONE NUMBER (optional):
0 0 3; 4-)t
CST SIC T R
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83)
OVER
-
Form -STC-104
AS BUILT SANITARY SYSTEM REPORT
OWNER 13r, u C,~ o. TOWNSHIP ` e C% h SEC. a 8 T 3 ON-R~W
ADDRESS ST. CROIX COUNTY, WISCONSIN
X10 ~ U
SUBDIVISION LOT LOT SIZE
PLAN VIEW
Distances and dimensions to meet requirements of 11HR 83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
1sky0 D3 p
iU031
3eor?-obrrl
LI I O kidrn.~
i 1 17'
tg~
I
I I
I
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference point used ~t~ e_~ ItO~ rJ~~ U ! 1 J
Elevation of vertical reference point: 100, r\ Proposed slope at site:
I ll ,
SEPTIC TANK: Manufacturer: W C(z S Liquid Capacity: ('J 0'J J
1
Number of rings used: Tank manhole cover elevation: ~Q o~ t
Tank Inlet Elevation: U v ^31 Tank Outlet Elevation: 00.
~
Number of feet from nearest Road.: Front
,Q Side,o Rear, O U U e J feet
From neare8t property line Front,0 Side,O Rear, Q 311 feet
Number of feet from: well 0 4' , building: J
(Include this information of the above plot plan)( 2 reference 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 F't.
Number of feet from well:
Number of feet from building:
(Include distances on plot plan). S ~o 8.3
loo 00
SOIL ABSORPTION SYSTEM 10-8 . ? ~o ~ N q s . 1 , c~,r
g V 4 A,
Bed: Trench: 13-0
Width: 1 Length: Number of Lines: Area Built: (C~ lJ
Fill depth to top of pipe: a y
Number of feet from nearest property line: Front, O Side, ( Rear,O Ft
Number of feet from well: Cx Vxl
Number of feet from building: 3
(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 0 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, O Ft.
Number of feet from well:
Number of feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
}
Dated: C, Plumber on job:
License Number:
3/84:mj
VOCATION: TOWN OF ST. JOSEPH 28.30.19.2$$ QQ NW VAL X ~Igw =AIL
L. La isconsin Department of Industry, PRIVATE SEWAGSY z ounty:
r andr Human Relations
d Buildings Division INSPECTION REPORT
Safety
_LATTACH TO PERMIT) sanitary ermit o.:
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
WANG, BRUCE ST. JOSEPH
- -
CST ~Elev.: Ins~BM Elev.: , BM Description: ^ Parcel Tax win-in7R-90-010
TANK INFORMATION CCJJ Vv 33Y~'1 NLLJELEVATION DATA A9200232 j 1/1 (Z
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Aeration Bldg. Sewer
Holding St/ Inlet 1 ' /C01
TANK SETBACK INFORMATION St/ Outlet CJ1~,35
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Sptic ' >jeld' /S, NA Dt Bottom
D: g NA Header f-M.,7. /2.39 ' S, to
4voff
Aeration NA Dist. Pipe 1Z,5 , S /
Holding Bot. System 2~ 9,Z
PUMP/ SIPHON INFORMATION Final Grade
Manuf Demand t070 04:-, S. 7' 6.6-6, d.?,
Model Number GPM
TDH Lift Friction System TDH Ft oss ead ~
Forcemain I Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
T Inside Dia. Liquid Depth
BED /TRENCH Width Length No. Of Tr ches PI f Pits
DIMENSIONS e DI EN I N
LEACHING Manufacturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION TypeO cIntf-, CHAMBER Mo um er:
System: X40- 7 OR UNIT
DISTRIBUTION SYSTEM
Header /4b4af►i4eld- Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length 1 , Dia Length 3 7 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over ~ Depth Ove~ It r. xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Z( Bed / Trench Edges 7Z Topsoil E] Yes 11 No El Yes ❑ No
COMMENTS: (Include code discre/paan~ciies,,lpersons present, etc.)
jrj
~'J 7~
j ( S .l/~. eG 7/h
(%k ZX cam' /~~yt .C/,e~
r" ~ z
(4- r
Plan revision required? ❑ Yes
Use other side for additional information. k;212- 1,9~
SBD-6710(R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: „may
a
i
SANITARY PERMIT APPLICATION
(~tDILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY
st C
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ J I ~ j
8% x 11 inches in size. C ec if revi on to p vlous application
-,See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
~Le WAN W'/aNW'/a,SaS T30,N,R I E(or4
PROPEEITY-OWNER'S AILING ADDRESS- LOT # BLOCK #
NBI
~S eri r~p>~ LPIJA NA
CI R, STATE r ZIP CODE PHONE BER SUBDIVISION NAME OR NUMBER
CITY NE EST ROAD
0 j-
II. TYPE OF BUILDING: Check one
( ) ❑ State Owned VILLAGE S Se
N j .
11) Ft I
Public N10 OF:
1 or 2 Fam. Dwelling#of bedrooms PAR LTAXNU BER )
❑
111. BUILDING USE: (If building type is public, check all that apply) SO _ /0 - '70 010
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 80 Mobile Home Park 120 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.X New 2.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 6Seepage 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
4 O REQUIRED (sq. ft.) PR PCE O D (sq. ft.) (Gals/da /sq. ft.) (Min./inch u Feet ELEVATION
74(3 14-1-01, , / o(Feet 7 9 aeet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncr t Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank o 0
Lift Pump Tank/Si hon Chamber 1 F1 1-1 F1 I El 1-1
Vlll. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plu er's~Signa re: (No Stamps) MP/MPRSW No.: Business Phone Number:
Plumber's Address (Nree City, State, Zip Code
0$ I~ e~ ~NjVdw S r.
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater E e Issued Iss ' g Agent Signature (No Stamps)
KApprOved ❑ Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
r
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sarrit3ry 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 131/2 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.
S8 D-6398 (R.11/88)
APPLICATION FOR SANITARY PERMIT
• I
S T C - 100
This application form is to be completed in full and signed by the owner(s) of
the property being developed. Any inadequacies will only result in delays of
the permit issuance. Should this development be intended for resale by
owner/contractor,(spec house), then a second form should be retained and
completed when the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property 45AAZE UIj+Al
Location of property -/VW 1/4 1/4, Section, T-3 N-R-22-W
Township ~ \J S EP/
Mailing address Z,22, 3 7 DOLLY V C,- ILLS
Address of site I/jQu Cy V / ~fj-~ L
Subdivision name
Lot number
Previous owner of property
Total size of parcel /A ~ S /
Date parcel was created
Are all corners and lot lines identifiable? --X-Yes No
Is this property being developed for resale (spec house)? Yes No
Volume 15-0 and Page Number 4-0cr 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. y_3a 1 3 ; 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 1 recorded in the Office
of t ty/Reegg~i'-t Deeds, as Document No. _ 3-17 _3 i
Signature o weer °
Signa urn of Co-Owner (If Applic le)
Da of/Signature Da a of, ignature
a 1 1~4l111Ai tyw,..
a'PAts sits 0V;WIM000` s..
At
peter l►. Torgerson and Gloria M. Torger,
NAUZ
as int tenants* Y1
.
• 8:30
-
Bruce !t. Nang and•MarY......-- _ F
emus) and warrasts to
~htctliAf.Ai 9,..t~tt;l~a►adAW4...i survivorship......
-R -
I RETUN TO
• - - -
the following described red estate in St-. CX91X..... . . ....county.
State of Wisoonsis: Tax Pared NO:
j .
S fRAN& , n T
part of the NW 1/4 of NW 1/4, of Section 28-30-19 described a
1
follows: Lot 1 of Certified Survey Map filed March 25, 1991 in
Volume "8", Page 2339. TOGETHER WITH a 66 foot wide access
{ eassment as shown on Certified Survey Map in Volume "7",
page 1856 and also ingress and egress over that parcel described
in Volume "694", Page 63.
This Deed is given in satisfaction of that certain
fl Land Contract dated April 12, 1991 and recorded on
April 16, 1991 in Volume 898, Page 408, as Document
Humber 468273.
This is not homestead property.
(is) (is tat)
Fxeeption to warranties:
Subject to easements, reservations and restrictions of record.
day of
bated this / ly 92
4SEAL)
• F- R A. TORGERSON
I ~ t: 1 I. r (SBAIa
].trRTA M. TORT ,
AUTBENTICATION ACHNOW LEDGMZNT
Signature(s) Peter A.. Torgerson .uui STATF. 1tF WISCON,1\
G i.. -Torgerson.- t'ount}'.
authenticated is . LZday of 1^ I't•r< malls t:uuc ht irrre me this day of
1.1 _ the al,ove `nameri
• STEPH N J. UNLAP
TITT,E: MEMBER STATE BAR OF WlS,COXSIN
ail
t►W► i 71>~/79fiA6/ 7~•/ lti ~ r•. • {,n «,r to he tl u ext-cuted the
.<anu•.
n: irc ur-trunurrl ul :wkm.wlo-la the
TN:S INSTRUMENT WAS ORAFIFD nV
STEPHEN J. DUNIA11
Hudson, Wisconsin County. Wis
(SIv atures may he authenticated or acknowlcd:~ed. Rr.t h \l r' m i<-nm Ir m r:nar.r n+. i I t not. 4atr espa!aitoh_
are no` necessary.) date: I!.
col persoms P*UiOR In any raP&64 should b,- ty;-1 M- lb-.,r
" 5
i
wr
2 5 Al C'MQ5
_ JAAILCS,O-CON o r v
APPIN)VED Rogwer of Demo
St Cft C~0.' W,
MAR 2 0 1991
,L
ST, C:t K?Ix c out4 fY C !P
rL~dJtarr Unolatted lands ti
C.I
West line of the NO of Section 18 -"I_ j
SOO0J6'14"W S00036'11,llw
- _ _ j~ ~.~L.
2166,661
EASEHENI FOR INGRESS ANO E aESS x61.721
N00236 1 14"E 469.92' ~
OUTLOrr a
( 469.92
N r~
o I 15,968 Sq. Ft, I^ °
I CJ ay
'c to
0.37 Acres o. o e
n I „ to vN m
m O
1 a 1 n ~ N
do
In
Ih
I ti
oo 1 t4+
l y1 I C
1 rn 1 7 t'r
0
r' 0 O 0
f) ; O Z Ai-
_
cl OD co Z
k-0 to
N N IL
1
C7 i~ l.. W ~a O ft
C' 7
~ .p m .p ~ p• F7't
I w C,n C~ i d 0 27
1 r* N U1 O I rr
is n o t~ la M T
. r r n.0 I r (n
o " 4 4 6 ca rt 10 ~
0- C> 4
-4 Ln I IA
N 0 r►t' C=
Cl r 3
r1 ,l• W1 ~ • 4
2
M • \ J
T w " O 0
A V
_I
wr A
e s a 7 ' ►a-+ b Q O 0
a r,, • rt
~ o M rt 0
1Y
C A R ~ N
g QD ~ O ~
y• N 7 7
N-
Ic- SU2033' ~'•3"E
470.63'
rr e
I. C
Unplatted Lands
r•, r. Bearings are referencte
to the west
1 r~ line of the NW} of Section 28, assumed
v; to bear 900036'141Iw,
rl is instcIminl drafl.ed by Fran Hetls Ceh P1 0j, No. 84- • 191 VOLU~SC 8 PAGE 2339
• ,SrJRVF,Y()R'.5_(_ERTxE'ICATE
25 continued
.I., Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify
r.I'":.I)Y the direction of Peter A. Torgerson, I have surveyed, described
"'nd napped the land parcel which is represented by this Certified Survey
NA[),' t:h at; Fire exterior boundary of the land parcel surveyed and mapped
i cIE ;r.ri~afr+a as follows!
parr-ol of land located in part of the N144 of the NWk of Section 28,
i'Y't`t, P1914, Town of St. Joseph, St. Croix County, Wisconsin; further
fellows:
al the 1,1W corner of said Section 28;
thence S00036' 14 "W,
'I!''rr!l ',F> r_ r U n,, of the N1•14 of said section, 461.72 feet.; thence
J;:, 66-00 feet to the point of beginning of this description;
':1ir'~►~" orr+:..inuing S89023' 46"E, 1052.06 feet; thence 902033'19"E, 470.63
J'"'('t; t;)enc.e N89023146"W, 1.078.00 feet; thence N00036'14"E, 469.92 feet_
fr') the point of beginning. Above described parcel is together with a
1;6 fo''t wide access easement as shown on Certified Survey Map recorded
t' Vol "'art" . Page 1856 ar_ Lhe St. Croix Count Reister =,r1ti a? ,r,gr-eCS and egress over that parcel. described inf Voleeds office
ume 694,
T-tcje t~.3 recorded at said office. Parcel described. above is subject to
M1, .l -I+JISements of rscord.
I also certify that this Certified Survey Map is a correct representation
of the exterior boundary surveyed and described; that. I have fully
4!i l: l7 the current provisions of chapter 236.34 of the Wisconsin
itintut:f.s and the Land Subdivision Ordinance of the County of St. Croix
i;i sirrveyinq and mapping same.
41
AIR 'liVb
Approved by the Town of St. Josesph
~r,rt.e Camille Grant, Clerk
t'k>tF': `11i'' z•o',dw-ly easement shown on the face of this map is a
P private roadway easement
" Est c7f the private roadway, after it's approval by the Zoning
n; „r r cr. eltatlOard road, shall be shared pro-rata by the adjoining property
thl-, private roadway be taken over by a municipality as a public road,
tl ereaf. ter W-DUld be a public expense.
VOLME 8 PAGE 2339
X11
0 1
r
"t
SEPTIC TANK MAINTENANCE AGREEIIENT rr
G~
St. Croix County
• c~
01MER/BUYER r?
0
1l..1.L.
ROUTE/BOX NUMBER Fire Number
CITY/ STATE ZIP-- r?
PROPERTY LOCATION: Section, T N, R-19,W,
_ St. Croix County.
'"Town of
Subdivision Lot number.
.improper use and maintenance of your septic system could result in
its premature failure to handle wastes.- Proper maintenanr,- con-
sists of pumping out the septic tank every three years ?oner,
if needed, by a licensed 's'ept'ic tank pumper. What. .you _nto
the system can a ect the tun ctionof the Wepr~•c ''=enk + 1 `r. gar-
ment stage in the waste disposal system.
St. Croix Count 71 residents-may be eligible to recieve a grant for
a maximum of 60% of the cost.of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new 's't'ems agree to keep their system properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or..a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and .(2)•after inspection and pumping (if nec-
essary), the septic-.tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year-expiration.
H
I/WE, the undersigned have read the above requirements and agree o
to maintain the private sewage disposal system in accordance with N
the standards set forth, herein, as.set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zonin Office within 3 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office I
911 4th St.
Hudson, WI 54016
386-4680
Sign, date and return to the above address.
D:EPARTMENTOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
..DEPARTMENT
INDUSTRY, DIVISION
P.O. BOX 76
LABOR AND PERCOLATION TESTS (115) MADISO
N WI 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: TOWNSHIP/Nffd#F+6iR~LLT : LOT .:BLK. O.:SUBDI I ON NAME:
IV 0 '/a t/'J'/a /T / f (o 56. To s.e
COUryTY- OWNER'S/BUYER'S NAME: MAIL G ADDRESS: 1" 10 - 1 L4 oil r;0
-401*
USE DATES OBSERVATIONS MADE
NO.
Residence BEDRMS.: COMMERCIA ESCRIPTION: Vew ❑Replace PROFI E DES RIPTIONS: ER O ATIO ESTS:
A/ /
e~Al RATING: S= Site suitable for system U= Site unsuitable for system
O. V TIONAL: MOUND: IN-G OUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional)
rVyjl% LO&Z ❑U ❑S U S ❑U ❑S JNN ❑S FR ~oh!/k,~i' /awl
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: \ 3 Floodplain, indicate Floodplain elevation:
PROFILE DESCRIPTIONS
BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
92- 84 As y.~. 33`i3"is
B-
~ SS ' • -s B/s . S ~ 13~ s~ . 9aBs~ /.r~/g.-, ~ 9z 13.E ~¢y.--,
B- Z Q, ~'Y 00. S
04 .11 s z sr 'A, 917' SS'B/s 1 j %el" 3rn /_r /I 92 2 . 7 Bv s g
B- Igo e- Sdfwl
~ G.O~ ~ 9 y 3 j 4 2, 5_, r,
B- 17
i'
B- 9,1L
7,47 9-5, >7 4 -7 B-
e PERCOLATION TESTS
DEPTH WATER I HOLEG TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
kTE
jtu= AFTERS LLIN INTERVAL-MIN. PERIO 1 PER10 2 P OQ3 PER INCH
17 it r 3
s` /A 1 <S Ida 21, 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
E E
E
b*_ bile
s
_61e, 5;:k
E
ov?3
V) 0
E ,
E
E E
E 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 (prin TEST WE E COMPLETED ON:
/
ADDRESS: CER IFI ATION NUMBER: PHONE NUMBER (optional):
~ `~,1 s-~4 00 PH? 1.71,10 30 4
CST SI T Ry
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
r-
1"" 'TRUCE',INS FOR C rMPL_ET1 0 FORM 115 - SRO - 6395
To be a coo e =oil t< ~rport must mclude:
ll. complete,
2. The use sr, indicate L s a residence or cominerc:ial project; ,
3. MAXIMU ass use planned;
4, Is °h,
complett t A IS SUITABLE FOR _DING TANK ONLY I ALL
OTHER SYS, ~ C UT BASED ON SOIL C.ONDIT
0. PLEASE use (anons `1 n here foi. writing profile descrit:>ti( a ~I completing the plot plan;
7. MAKE A ~grar locating your test locations. ira g scale is preferred. A
atr st y >e: used if
F. chroark r id _atio'i reference paint a~ ~ sand are permanent;
0. Complete all a riate boxes as xs, names, addresses, flood pt n, rcolation test exemp-
tior3, if acs,
10, If the °s} does rat- place N.A. o) the appropriate box;
11. Signs tl° at,d your c Lion number;
12, bake any` c crib- _e as r iced. ALL SO TESTS MUST BE FILED WITH THE
LOCAL. ~ FY WITHIN 30 (SAYS OF COMPLETION,
e
EVI T O OR GERT FL _ - l T~F S
I Textures yoibols
st: r 10") RR Be, rock
cob - 10") tone
gr Gr Eder 3") arse
~ oundvaater
r ld ion Rate
rY ~,a1C1
C
3`s
.ri
BI B
Gy G,-a~
t~ Y Yellov";
L warn R Rent
L -gym nsut - Mottles
y ,:_r Wi"I
sir: clay - f r, fuse= faint
f' mnion, coarse
I. Y, rned;urn
in - `incl:
p p rninent
HWL - 1.
PM- I-' r.
VRP ._'`,ai R
ii
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.
mss;,..
R, L G 7 P _'OSS SEC-1 I 1\1
_LOTA H 1) R
N A M E
kl'-. 0CA I O N _l_ IC E NS -f-
-f. _ _Y.__._...
_ AIT E
Nc, a d Qd,~c~u 1~fir 1e ~ ; S~ee~ ~6j , t.,
~0_ 'T ~'Grj X 00' rk.yv. sad ti txfi fi" $
S-~ ~1 ~ s~ r erg Bw)It LI. TKIee ICL- IDo,u
.
ti 1 J ~JOILd b l -C )
At Q
a~ I
~Ak
SovaC~. P~ x ~ a0 3 aeD I U1> Y1
1 ,
V po BS We 1/0
4 ` ' Q4`'
FRESH All'. INLETS AND OBSERVATION PLQE
C1:OSS SECTION
Approved Vent Cap
Minimum 12" Above
, Final Grade
4" Cast Iron
Above Pipe Vent Pipe
To Final GradC.
:1.
Marsh Hay Or Synthetic Covering
Min. 2" Aggreg';do -
over Pipe
Dist-ribut-io!;>. Tee
Pipe
Aggregate N14 erf.orated Pipe Delow
13encath Pipe ,_-Coupling Terminating r
Bottom of System
REPT1„31 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1
7,1/10/92 09:46 REQUESTS FOR INSPECTION WORK SHEETS FOR: 11/11/92 AREA: JT
Activity: A9200232 11/11/92 Type: CONVSEPT Status: PENDING Constr:
Address: TOWN OF ST. JOSEPH 28.30.19.281A10,NW,NW, VALLEY VIEW TRAIL
Parcel: 030-1078-90-010 Occ: Use:
Description: 171467
Applicant: WANG, BRUCE Phone:
Owner: WANG. BRUCE Phone:
Contractor: BOUMEESTER, JIM Phone: 386-9020
Inspection Request Information.....
Requestor: BOUMEESTER, JIM Phone:
Req Time: 09:11 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
I
i
I
~1