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HomeMy WebLinkAbout020-1282-70-000 FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~l~Yi✓ el~ TOWNSHIP SECTION /7 T alr N-R./4?W ireG3a,r/ Gc/ ST. CROIX COUNTY, WISCONSIN ADDRESS SUBDIVISION SIZE S~c~a.eKs PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~t N 1-~~cse INDICATE NORTH ARROW BENCHMARK: Elevation and description: Alternate benchmark SEPTIC TANK:Manufacturer:-,~ Liquid Cap. Rings used:.-Manhole cover elev.- Final grade elev: Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road:Front,,&, Side , Rear Ft. From nearest prop. line:Front Side, Rear Ft. No. of feet from: Well,&drBuilding: rS (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE i PUMP CHAFER 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. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: /,'Z Length Number of Lines:_,,? Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: go. feet from nearest prop. 1 ine : Front , S ide off, Rear Ft . ;2A No. feet from well: yrd`- ` feet from building /lam 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: DATE : PLUMBER ON JOB : LICENSE NUMBER: /f/' 6/90:cj nLVARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUIKIAN RELATIONS DIVISION P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION Fstate I.D. Number: q~ 4, eC.17,T29-R19 (if assigned) W Town of Hudson, Lr~t~, 10tS"J CONVENTIONAL ❑ ALTERATIVE u Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: AINSPECTION DATE: Bill Harwell . Rd. UU Hudson,, WI ( (0/0 ST REF. EV. Sz ENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: PT. EL Name of Plumber. MP/MP No.: County: Sanitary Permit Number: Wm. Schumaker 6382 St. Cr x 128887 a~rna e ayL ~v; Y SEPTIC TANK/HOLDING"TANK:41 MANUFACTURER: LIQUID CAPACITY: TANK INLET E K OUTLET ELEV.: "WARNING LABEL LOCKING COV R PROVIDED: PROVIDED: (,~,fE+.; /p(J!>,.~❑NO ❑YES BEDDING: VENT DIA.. VENT MATL.: HIGH WATER ^ NUMBER OF ROAD: PROPERTY WEL BUILDING: VENT TO ESH ~~ALARM: I /J~ FEET FROM LIN/~ / AIR I E ❑ YES [`4<0- ❑ YES /LafJf N`O NEAREST DOSING CHAMBE MANUFACTU E':LIQUIID CAPACITY: PUMP PUMP/SIPHON MANUFACTURER: pgOVIDEDLABEL pVIDEDOVER NO ❑ YES ❑ NO YES ❑ NO GALLONS PER CYCPUMP AND CONTROLS OPERATIONAL: R OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETFEET F LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST LENGTH: DIAMETER: MARKING: SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue. CONVENTIONAL SYSTE IO' 1_,e-(1-1 ~S WIDTH: L NO. OF [DISTR. PIFIE SPACING:_ COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH / I TRENCHES: / TERIAL: / DIMENSIONS o2 p 'C- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERI O I TR. NUMBER OF PROPERTY/ WEL BUILDING: VENT TO FRESH BELOW PIP~S~, ABOVE/C VEELEV. INLET: ELEV. END: i1 /1 / PNI 'L I ES: I FEET FROM LINE: ~S(~~ / AI,R'INLET: / avYY 'j: NEAREST ZO l 11.D (may//► 17 MOUND SYSTEM: Mound site plowed perpendicular heck the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslop mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES ❑ NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRNO.OF ENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST ~ ,.2 Retain in county file for audit. Sketch System on Reverse Side. SIGN LIFE: TITLE: SBD-6710 (R. 06/88) a SANITARY PERMIT APPLICATION CouNTY In accord with ILHR 83.05, Wis. Adm. Code ~wa -Now STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 6 07 r i t 8/z X 11 inches In size. El Check if revision to 7evious 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 i~ , ,.,i 5 , t/a _ t/a, S T.,~ N, R E (or)~►i. PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # c~ 'T l Al CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) ❑ State Owned ❑ VILLAGE ❑ Public- 01.or 2 Fam. Dwelling-# of bedrooms _~L PARCEL AX NUMBER(b) 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 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. EZ 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 ❑ 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 1. - ELEVATION 4/ 5V e!~ / / 3 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Hoidin Tank X ; 1 Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Business Phone Number: Plumber's Name (Print): Plumber's Signature: (No Stamps) MPRSW No.: r3 % ' la. r y~ Z._JP; k Plumber's Address (Street, City, State, Zip Code): v iv T / ~icC%~ ✓ L✓ r IX. C TY/DEPARTMENT USE ONLY ❑ Disapproved 7ination Permit Fee (includes Groundwater a e ssue ssuing Ag nt Signature ( Stamps) Surcharge Fee) '2 61. e15 Approved ❑ Owner Given In Adverse Deter X. CONDITION S 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 l'a~~ r ,le l Stt.~,~' s'G'. i j ;z~ /c~lf'~1 (lore R ,c E~.s7 orrnl ij r I .z i f 3 4y ' ~ l ~ 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~ C ~ Location of property_/1/4 -1/4, Section r '7 , T o~~f N-R _W Township rSd-y Mailing address C r Address of site 4!_~l' fir. ~L ter. e~-f L1, Subdivision name d,`//~r~ Lot number Previous owner of property r-- i Total size of parcel e-cY'-e- .5- Date parcel was created a-7 Are all corners and lot lines Identifiable? es No Is this property being developed for resale (spec house)? es No Volume , and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. -0-:2 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 Sr. jCR,OM Cp. wq. n. \ ryt'.q ,`~5[y~*, Y is f'• 4 Y-Y4yy~ Wr „~[r W, Aft s ter: } k * Coutract.14 and between Armol4,#a. ;fertelses a4hc/a.~#► It rtelsen 7irginia : A. 11ortelsen," huabsndaad /eador, ¢apd'hl zi H: velopoeat, ' Iac ` a Wisconsin corporation, r 'a yr ¢•~^-"11y, Ti`}'lti~''-mil it1` t".S.,t~' k t Vendor, "lie' and agrees to. s T to.'Purclweri upon"the pc vapt" and full `performance of this Contract by rprdm er the following; property, together with she tarts, profits and other a ppartanaat'est.callyd the ."Property") ` 'in St. Croix County, State of ilLecooain. South 53 1/3 rods of South Half_ol.Southwest Quarter (Sk-M) and South 53 1/3 rods of Southwp@t Quarter of Southeast ,a4 Quarter (SWWt) of Section 17~ TM, R19W. That part of Northwest quarter of Northeast Quarter Mt nt) and of Northeast Quarter of Northwest Quarter (Mgt NWT) of Section 20, TZQ.N .';"fi19W, lying Northerly of the centerline of St:-'Croix, County Trunk'Higbway "A" t, (formerly kncwm as Hudsou-New Richmond Highway), EXCEPT the following parts of the above described tracts: All land included witLin the Plat of Willow Ridge Second Addition to the Torn of Hudson as described in Vol. 4 of Plats, p&ge 25; Parcel deeded to Marlin 0. Amdahl and Ruth L. Amdahl as described in Vol. 517, page 26, Document No. 324368; Parcel deeded to Roger Hatchler as described in Vol. 517, page 114, Document. !lumber 324430. TOGETHER with an easement for street purposes over the Easterly 33 feet of said parcel deeded to Roger E. Hetchler as described in Vol. 517, Page 114, Document Number 324430. SUBJECT TO the right-of-war of said St. Croix County Tru.~k Highway "A" and to telephone easement adjacent to said highway as recorded 3: in the office of said Register of Deeds. Purchaser agrees to purchase the Property and to pay to Vendor at: St. Croix Heights, Hudson, Wisconsin, the Base Purchase Price of $100,000.00, together with F additional payments per lot, as follows: 1. Base Purchase Price. The base purchase pr!ce of $100,000.00 shah be paid in the following manner: $15,000.00 at the execution of this Contract, and the balance of $85,000.00 together with interest on such portions thereof as shall j remain from time to time unpaid, at the rate of 10% per annum, until paid in full, as follows: I (a) For each individual lot developed and sold by the Purchaser, Purchaser shall pay to Vendor a $2,000.00 principal payment, to be applied to the $85,000.00 base contract balance outstanding. (b) A minimum annual payment of $15,000.00 principal shall be paid each year, excluding the year of sale. Each oer lot principal payment required above, shall be credited toward this $15,000.00 annual payment. (c) On December 1, 1985, and on December let of each year thereafter, Purchaser shall pay to Vendor the differential between the.requiced minimum principal payment of $15,000.00 and the total $2,000.00 per lot payments made during the preceding twelve (12) months, until the Base Purchase Price has been paid ;n lull. (d) Interest on the principal balance of $85,000.00 shall accrue from the date of closing, with annual pa,nnents of interest due on the lot day of December, each year, commencing December 1, 1984. WILL b/les 2. Additional Per Lot Payments. In addition to the foregoing Base Purchase All T AIIAN Price payments, Purchaser shall pay to Vendor additional per lot payments totaling not less than $;50,000.00, as follows: Tu"W" Sq e 502 SecomS1 (a) No interest shall accrue on the principal sums paid to Vendor Ht~.wn under the terms of this Paragraph. 51016 11S386 6231 „ v 46 Purchasar shall pay to Vendor the sum of $3,000.00 per at on all.resideutial lots developed and sold by Purchaser, r ~subjeet to the condition that the minimum amount of payments to be made to Bertelsen under this Paragraph shall total at least $150.000.00. (c) Daring each year of this Contract that there is an outstanding contract balance of the Base Purchase Price (Paragraph 1(a)) there shall be no minimum annual principal payments under this paragraph. Commencing with the year following completion of payment of the Base Purchase Price, Purchaser shall pay to Vendor a minimum annual sum of $15,000.00 per year. (d) On the let day of December of each year, Purchaser shall pay to Vendor the differential between the minimum annual payment of $15,000.00 as provided in this Paragraph, and the total $3,000.00 per lot payments made during the preceding twelve months, until the entire $150,000.00 minimum sum has been paid. Thereafter, if Purchaser sells any lots in excess of 50 lots, Purchaser shall pay to Vendor the am of $3,000.00 for any such additional lot sold, up to a total of 53 lots. ($159,000.00 total hereunder) Purchaser shall not be required to pay monthly payments to Vendor sufficient to pay reasonably anticipated annual taxes and special assessments. Any amount may be prepaid without premium or fee upon principal at any time. In the event of any prepayment, this Contract shall not be treated as in default with respect to payment so long as the entire balance of principal, and interest where required, is less than the amount that said indebtedness would have been had the monthly payments been made as set forth above. Purchaser states that Purchaser is satisfied with the title as shown by the Abstract of Title submitted to Purchaser for examination, except: Real estate mortgage to Sam E. Hiller, dated February 1, 1980, recorded in Volume "608", Page 152, Document Number 362685. This mortgage shall remain the obligation of Vendor, who shall keep said mortgage current and in good standing. In the event Vendor fails to pay any required mortgage payment, Purchaser shall have the right to make such payment, and to deduct any payment so made from the sums due under the terns of this Contract. Purchaser agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the property on Closing. Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditoos shall be full performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except, subject to utility easements and covenants and restrictions of record. Bertelsen shall have the right to purchase one (1) lot from B b H for the sum of 55,000.00. Bertelsen may select his lot after B b H picks its first five lots. -2- A 11 . VOL - ~~YY~~II r h ` Vendor shall consent to the platting of the premises into residential 'subdivisions by Purchaser and Vendor shall be under an obligation to approve and execute subdivision plate prepared and submitted by Purchaser. <v., f In addition to the Warranty Deed which Vendor shall deliver at time of ultimate closing, Vendor shall execute and deliver to Purchaser, individual Warranty Deeds covering the separate residential lots which Purchaser may sell, s•., upon payment of the per lot payments set forth above. All costs of platting and costs incurred in preparation of individual deeds shall be Purchaser's expense. r Purchaser at-sea that time is of the essence and (a) in the event of a default - in the payment of any principal or interest which continues for a period o of 60 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 60 days following ' written notice thereof b Vendor (delivered ' by personally or mailed by certified mail), ; then the entire outstanding balance under this contract shall become immediately and ' payable in full at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject k. to any limitations provided by law) in addition to thole provided by law or in equity; (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any ecuity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in ♦ffec: on such date and other amounts due hereunder (in which event all amounts prev:or:sly paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor nay sue for specific Peformance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this t:. Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from pobsession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under M, &i) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurree to ' enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as incurred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits I of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the Court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebt=dness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor may waive any default without waiving any other subsequen" or prior default of Purchaser. -3- .I f` IV 49 All terms of this Contract shall be binding upon and inure to the benefits t of the heirs, legal representatives, successors and assigns of Vendor and Purchaser (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this 29th day of May, 1984. VENDOR: PURCHASER: a { ~'r B• S H EVELOPIENT, INC. BY: / C = ~ Arnold R. Bertelsen a/k/a A. R. Bertelsen Donald E. Bjornat President ATTEST: Virg a A. Bertelsen William C. Harwell, Secretary 4v ~Op Authentication: _ Signature(s) of Arnold R_ Bertelsen, U o V_irrgini■ A_ Bartal■ n~ his vife, and t . © w SL: DonAid F_ a, ern■cad and William C. Harwell, President and Secretary respectively of B-6 H Develoymenr_ Inc., authentic day of May, 19 William J. Radosevich Member State Bar of Wisconsin. This instrument drafted by: William J. Radosevich Attorney at Law Hudson, Wisconsin 540t6. Y C.. STC - 105 r Y :ihPTLC 'L'ANK MAINTENANCIs ACIM , -',NT G St. Croix County o Y H u W h: it i Ii U Y L ItOUTE/BoX NUMBEA< Fire Number I'k"%Pl:RTY I.UCATIUN: ' Sect iuu T__ _N, R -W+ Town St. Croix Courtt.y, Subdivilsi.uu ';ot humbe r~. Improper use and malntenaticu of your .Sept it' sy` Li!m cuuld result in icy, premature ''tit lltire to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sootier., ii needed, by a licensed . ic_ tank 1~uutLer. What you put into t. lie systeut can affect the function of the septic tank as a treat - tutAut stake ilk Lite waste disposal systeut. St. Croix County residents utay be eligible to receive a grunt for it maximum of 607 of the cost of replacement of a failing systum, w It i c It was l it o f~ ratio1 t 1trier to July 1, 1978. St. Cruix County dk:ceiitc:cl this program iu August of 1980, with the ruqulrement that uwtiurs of all new stems agree to keep their systems properly, u,ulntained - The property owner agrees to submit to St. Croix Cuunty 'tuning a cur.tificatiun turn, sighed by the owner and by a master plumber, journeyman plumber, restriCted plumber or it licensed pumper veri- fying that (1) tike ou- site wastewater disposal system'is in,propur 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 clays prior to three year expiration. T/WE, the undersigned, have read the above requirements and agree u, to maintain the private sewage disposal system in accordance with Lite standards set forth, herein, as set by the Wisconsin Depart- 10 utent of Natural Resources. Certification Iorm must be completed and returned to the St. Croix County Zoning 0ifi<ce within 30 days of the three year expiration date. . S I G N E D DATE-- C.•o1x County Zoning 'Off ice SL . 1'.0.. low 96, Nammo'ltd, MIT 54015 715-7 16-2239 or 715-425-8363 Sign, date and return to above address. SAFETY&BUILDING DEPARTMENT OF REPORT ON SOIL BORINGS AND D N INDUSTRY, IVISION • 1 P.O. BOX 7969 LABOR HUMAN AND RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNS IP/ LOTNO.:BLK.NO.:SUBDIVISIQilNAME: 1 1/ %7, /TZq N/Rf 1 E (or) lasoti COUNTY: OWNER'S/BUYER'S NAME: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BE__7 COMMER IAL DESCRIPTION: PROFILE DESCRIPTIONS : E LA ION TESTS: OResidence r$~p~ New ❑Replace r_1i5 , r 7r I~Q{ M.1$~~ ~ t9q: S34 SUiCS <a ~1 CS- <Z - KNr11~ A? RATING: S= Site suitable for system U= Site unsuitable for system SAI T NTION COM S EIAL: MOU D:E1U I' S P ❑u RE: S121 YSTEM-IN~FILLHO ~ LDING TANK' Qr 'r~,T'0j,, 4 t:(option ) If Percolation Tests are NOT required FESI,~N, RATE: ~ If any portion of the tested area is in the r Y 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 IMF ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B ~.SrS /O2. E~4 r rt >9.Sv 13eLLTS "8Rn)C II Bie SG '77 1 AlSICIRi B- 1).C)6 /o3.3°t NoN > /O,OU "Bc •rS "8 L 3Z"&qN thS ZZ'&AAS169go~ ~ S B- - 9 /6, 7 ©Z 3' of l ~ > 9.0 z ' &c.rs "'8e,4 /fit' Qn! 2. B- l~.?~ lf~! /JoN~ > 7S Z4" >Bz~TS 13~ gQNL Z t `8k~r ~L 7! "$2 ill B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERS ELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER D PER INCH P. Z ~,.~D ritL'mr Ia3.1v >Z > > Z. P. 3 3 cj ,d2.3s > Z L C P P- ~(d i t1 4-r P i P"L 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 cyj J - i - i - I J-1 i 15 y ' q5 _ ~ , -j- i , i t _ - - 1 r -I-- 1 I T , I, the undersigned, hereby certify that )he 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): ` TESTS WERE COMPLETED OfV: 14X1 = t~N`at~•N 1tWSON JUR Y Ilyek W awl /91/ ADDRESS: CERTIFI A 10 NUMBER: P NE NUMBER (optional): %6 c) CST SIG URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - ,yE•saoti 600'09T ,00-095 ,TE'602 ,00'VOE ,00,9LT 102 103 104 0. 105 106 co I 1.368 AC. o 1.308 AC. I 1.317 , AC:m 1.254 AC. 1.281 AC. M Cl N t cu crl O cn cn cm m 209.84 206.62 182 88 p p5s db E~ t , E9' Tc; 282.32 OVERLOOK ' dd'g~t . 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